Academic Ceremonies October 2008

“From seeking health to finding healths”

Bigger isn’t always better. Cooperation and scaling up in sciences is seen as a way to realizing ambitious objectives. That is why in nutrition sciences large teams cooperate on genome analyses to contribute to healthy nutrition and to public health. The question is whether this objective is ultimately reached. The fact is that nutrition research itself generates standards for health. This research shows that in large-scale research many standards for health generate. Large-scale nutrition research produces many facts about the effects of separate substances on our body, but the opinions on what is healthy differ even more than before. In brief, large-scale research can be effective for the production of knowledge, but for understanding health, it is less effective.  

Co-financed by NWO

Key words:

research, nutrition, health

“Design of a competence-based assessment system for air traffic control training”

This dissertation describes the design, properties and evaluation of an innovative assessment system that has been implemented since 2003 by Air Traffic Control the Netherlands for simulator and on-the job training of air traffic controllers. Because the required competences for air traffic controllers are described, this has created a common idea of what coaches can expect of trainees in successive training phases. This has increased the objectivity of assessments. Coaches can better identify the trainee’s strengths and weaknesses and give better support. On the basis of the competences already in the selection it is possible to predict which candidates could acquire the complex skills of air traffic controller.  

Key words:

air traffic control, assessment systems

“Accounting for Trends”

Managers and investors want future-oriented information in the (external) reporting of firms. The use of momentum accounting makes value creation visible with a new financial ratio that works as a speedometer on the corporate dashboard. It appears possible to pronounce rather accurately on the development of the own capital in the future of companies that are listed on the Dow and the AEX. In this study, the Dow Jones index is correctly predicted with spectra map analyses. The development of the own capital of companies can be followed and predicted on the basis of models that were developed in this study.

Key words:

momentum accounting, spectra map, future-oriented information, AEX, Dow Jones index

“Cancer Rehabilitation”

A cohort study of cancer patients with physical and psychosocial complaints after their medical treatment showed that a group rehabilitation programme with physical training and psychosocial theme meetings had positive effects on the quality of their lives.  On the basis of suggestions for improvement of these patients, two new group programmes were developed: a physical training programme and a programme that consists of this physical training as well as psychosocial training. Immediately after rehabilitation, both the participants of the physical training as the participants of the combined training reported greater improvement in quality of life than those who did not participate in rehabilitation. Nine months after rehabilitation these improvements still applied. Since there is no difference in effectiveness between physical training and combined training, and physical training involves less time and lower costs, this could be included in the standard oncology care. 

Key words:

cancer, rehabilitation

“Over de kwaliteit van detentie” (“On the quality of detention”) 

“D-optimal designs for prospective cohort studies”

Many researchers are performing a study in which subjects are measured repeatedly over time. Purpose is e.g. to study the change in quality of life over time after a severe traffic accident or how patients recover in time after some medical treatment. Such study may be expensive due to large amount of subjects and number of measurements for each subject. Therefore, careful planning is necessary to minimize the costs and still obtain reliable results. The thesis deals with planning of a study in which subjects are measured repeatedly and gives solution of the optimal number of groups of subjects, the optimal number of measurements per subject, and when should subject be measured. A computer program is developed to assist researchers to addressing these objectives.

The project is supported by the Care and Public Health Research Institute (Caphri), Maastricht University. 

Trefwoorden:

Optimal designs, cohort studies

“Reflex or Reflect ? Implicit and explicit cognitive processes and early intervention in adolescent alcohol use”

Traditionally, intervention programmes are aimed at pointing out the damages of alcohol use. However, it is naïve to think that adolescents drink because they cannot sufficiently consider the pros and cons. This dissertation shows that the drinking behaviour of adolescents is influenced by both resolute rational considerations and more automatic associations with alcohol (for example: alcohol – cheerful). Moreover it turns out that especially adolescents with a lower executive control have their drinking behaviour largely determined by these automatic processes, whereas adolescents with a higher executive control primarily drink resolutely. In the development of new interventions more attention should be given to the influence of these automatic processes. 

Key words:

adolescents, alcohol use, prevention

“Marketing x Financiering = Product met Hoog Rendement en Laag Risico Profiel”

“New developments in diagnosis and treatment of deep vein thrombosis”

This dissertation describes besides studies of the treatment of thrombosis also diagnostic studies. With a clinical decision rule and a point of care D-dimer test, general practitioners can safely, efficiently and cost-effectively exclude a suspected thrombotic leg in 50% of the cases. These are the conclusions of the AMUSE-research that was jointly conducted by the universities of Amsterdam, Maastricht and Utrecht. This diagnostic strategy has been   included in the new GP guideline ‘deep vein thrombosis’.  

This research was financed by ZonMW

Key words:

thrombosis diagnosis and treatment

“Visual outcome and patient satisfaction after corneal and Refractive surgery”

This dissertation studies two surgical interventions that correct the visual strength of the eye: the eye laser treatments that correct low to moderate myopia, and artificial lens implantation techniques that correct moderate to higher myopia.  The patient satisfaction and the subjective quality of the vision were high after the treatments. Statistical analysis showed that also the objective vision sharpness remained high. 
Furthermore, the dissertation stresses the importance of extensive information and of standardization of various studies in the selection of suitable candidates, such as measuring the pupil size, optical failures and the number of living cells of the innermost layer of the cornea. One of the conclusions of the research is that when strong selection criteria are used, the majority of the treated patients are very satisfied with the result of the surgery. 

Key words:

myopia, vision correction

“Fracture prediction in primary care: more than bone alone”

Also due to the ageing of the population bone fractures have become an increasing health problem. The costs and the mortality related to bone fractures increase considerably. It is therefore of medical and social interest that bone fractures can be predicted. With the help of the three predictors (1) an earlier bone fracture, (2) osteoporosis, and (3) age, the 10-year risk of bone fractures in post-menopausal women of 50 years and older can be determined. The most important predictor is a recent bone fracture. Without preventive treatment post-menopausal women suffer 1 out of the 4 next bone fractures within 1 year and 1 out of the 2 next bone fractures within 5 years after a first bone fracture. 

Key words:

bone fracture, risk prediction

“An Inevitable Reference, an Inimitable Model: American Legal Culture and Globalization”

“Die Gesellschaft mit beschränkter haftung in Europa; Eine rechtsvergleichende Studie zum Recht der GmbH in Deutschland, den Niederlanden und Frankreich”

In the aftermath of the European Court of Justice's (ECJ) landmark decisions Centros, Überseering and Inspire Art, implementing the freedom to choose the applicable corporate law through the choice of a corporate seat that is independent from its real seat, a regulatory competition in company law has started in the EU, entailing company law reforms in a number of EU Member States, among others in France, Germany and the Netherlands. Glozbach’s thesis compares and examines the applicable and reformed company laws of France, Germany and The Netherlands taking also into account the progressive European legislation in that field of law.

“Alcohol consumption as a risk factor for colorectal cancer; An epidemiological study on genetic susceptibility and molecular endpoints”

Within the Netherlands Cohort Study into nutrition and cancer (NLCS) various aspects of the relation between alcohol intake and colorectal cancer has been studied.  It turns out that a daily intake of at least three alcoholic drinks leads to an increased risk of colorectal cancer; the type of alcohol appears not to determine the risk increase, but the total quantity of consumed alcohol. 
The results of the molecular studies suggest that the way in which alcohol can lead to colorectal cancer goes via a more general mechanism than via causing deviations in genes. Studied was also whether the degree of alcohol decomposition in the body (that is genetically determined) has an effect on the relation between alcohol intake and colorectal cancer. However, no unambiguous result was found there. The research results support the current guidelines for safe alcohol use as recommended by the National Health Council.  

Key words:

Alcohol consumption, colorectal cancer

“A qualitative study on the effect of lymphatic filariasis on women: experiences, needs, and implications for lymphedema management programs”

“Economic Evaluation of Change in Clinical  Practice: Methods for Informing Decisions  about Guidelines and Implementation Strategies”

Implementatie van klinische richtlijnen om de zorg voor patiënten te verbeteren, vereist economische evaluatie. Deze evaluaties wegen de kosten af tegen de winst in gezondheid.

In dit proefschrift zijn evaluatiemethoden ontwikkeld om te bepalen of er in implementatieactiviteiten moet worden geïnvesteerd en wat de maximale investeringsruimte is. Met behulp van deze methoden kan bovendien worden vastgesteld of verder onderzoek naar zorgverbetering, bijvoorbeeld door de ingebruikname van richtlijnadviezen voor medisch handelen, waardevol is.

Als belangrijkste conclusie geldt daarbij dat het beter is om integraal in plaats van afzonderlijk te beslissen over investeringen in implementatie, onderzoek en patiëntenzorg.

“The principle of numerus clausus in European Property Law”

This dissertation studies the differences and similarities in property law in the Netherlands, Germany, France and England. Property law concerns rights that for example a private person or a bank has regarding everyone, such as for example property and the right of mortgage. Central is the numerus clausus principle that limits the creation of these rights. One is not at liberty to simply make new rights regarding everyone. This study shows that the countries of the European Union all know this principle. The dissertation also makes proposals on how the European rules in this field could be formulated. From these proposals among others citizens could benefit, who want to acquire a house in another member state, but also companies and banks that operate across the borders.

“Nitrogen metabolism and hepatocellular injury during liver resection”

After an operation in which part of the liver is removed because of (malignant) tumours the liver function has to increase per gram of liver tissue to maintain the total liver function. In the case of insufficient remaining cell mass liver failure can occur. There is no good predictor of the adaptability. This dissertation shows that the total quantity of nitrogen in the blood can be a measure for the functional capacity of the liver. The dissertation also demonstrates that anoxia of the liver does not cause extra cell loss during the operation if its duration is limited. This may be connected with the intake of anti-oxidants and the production of stress proteins.  

Key words:

liver resection, amino acids, cell injury, glutamine, arginine

“Tracing Bipolar Disorder to its Developmental Origin in the General Population”

A bipolar disorder (before: manic-depressive disorder) is characterized by the repeated occurrence of episodes with very black (‘depressive’) and pathologically elated (‘manic’ or ‘hypomanic’) moods. This research shows that no less than 7.6% of adolescents have gone trough manic/hypomanic episodes (the greater part of which is not known to assistance), and that 37.0% of the adolescents suffer from ‘subclinical symptoms’; light expression of abnormal euphoria.  The disorder usually starts before the age of 22. Adolescents with subclinical symptoms run a greater risk of developing the disorder, especially is they have had the symptoms for a longer period already. Mania during adolescence therefore appears often a ‘normal’ and ‘passing’ development phenomena; you only become a patient if you get stuck in the mania. 

“Pattern Recognition of Brain Signals”

“PREVention of Asthma in genetically Susceptible Children (PREVASC)?”

“Disgust in specific phobias; a dirt road to anxiety disorders”

In this dissertation the role of disgust in several phobic fears (particularly spider and blood phobia) was studied. People who are easily disgusted of all kinds of things appear to run a higher risk of developing a spider or blood phobia. In the case of blood phobia the ‘fear of disgust’ also turned out to play a role. Because disgust is accompanied with physical reactions that can protect man against diseases, excessive avoidance behaviour is possibly a way to prevent (whether or not imaginary) contamination. The expectation that unpleasant consequences will follow the confrontation with a phobic stimulus (spiders, blood) appears in phobic persons not only to be related to a physical damage but also to contamination. Heart beat deceleration and lowering of the blood pressure appeared to be no part of the physiological disgust response. Therefore, the prevailing view that the characteristic faint at the sight of blood is a consequence of the disgust reaction is incorrect.  

“Assessing Induced Technology: Sombart’s Understanding of Technical Change in the History of Economics”

“Pro-active Medical Information Retrieval”

Central in this research is the question if it is possible to automatically provide doctors with relevant patient-related literature. In this context the computer system Medical Information Retrieval Agent (MIRA) was developed, which on the basis of electronic patient data independently formulates medical questions. Subsequently the system uses these questions as a starting point for searching medical literature. Evaluation of MIRA shows that the automatically formulated questions in most cases are indeed relevant for doctors. This applies to a lesser degree also to the literature that is found on the basis of the questions. By automatically informing doctors of recent medical developments MIRA could contribute to an improvement of medical care.  

Financed by NWO in the framework of the ToKeN-project MIA.

Key words:

information retrieval, medical literature

“Risk Management from a Microeconomic Perspective”

Risk management is of crucial importance considering the enormous financial risks our economy is exposed to. Inadequate assessment of risk played a crucial role in the current subprime mortgage crisis as well. In this thesis we study how to measure risk properly.  Imagine that there is a head-office setting risk limits for some divisions. We analyze how to allocate the risk diversification benefits by applying game theory.  We show that the head-office can always allocate risk in a stable way, and the less is the uncertainty regarding the whole firm, the higher level of discretion the head office has. 

Key words:

risk measures, microeconomic theory

“In Search of the Perfect Citizen ? The intersection between integration, immigration and nationality in the EU”

“Economic aspects of treatment for Borderline Personality Disorder; theory versus practice”

A borderline personality disorder (BPS) is a serious psychiatric disorder, for which until recently no really effective treatment seemed available. Recently it was shown that two new ambulant psychotherapies, the so-called Scheme Therapy and Transference Focused Psychotherapy (TFP),  are effective in fighting borderline symptoms. This dissertation elaborates on earlier studies by linking the costs that occur in both therapies to the effects. Not only the costs of the psychotherapy and for example hospitalizations and medication are taken into account, but also non-medical costs such as volunteer aid and productivity loss in paid or unpaid work. It turns out that the non-medical costs are much higher than the costs within the medical circuit. Although the quality of life considerably improved with both therapies, there was no difference between the groups in that area. The main conclusion is that Scheme Therapy, compared to TFP, in all probability is the most cost-effective treatment strategy. 

Key words:

borderline, cost-effectiveness therapy

“Sequential Auctions and Alternating Price Competition”

A central theme in economics is the functioning of markets. The field of industrial organization studies the strategic behaviour of companies, the structure of markets, and the interaction between those two. This dissertation contains research in the field of industrial organization. In the first part of the dissertation sequential auctions are studied. Bidders benefit from scale advantages if they win several auctions and it is shown that this has some negative consequences. Bidders possibly suffer losses and their average profit decreases as the synergy possibilities increase. 
The second part of the dissertation studies price competition between companies in an oligopoly. The companies can take turns in adjusting their prices by rigorisms. Shown is, among others, that prices fluctuate in a countercyclical manner.